title: The effort required to achieve and maintain optimal glycemic control.
abstract: BACKGROUND
  Insulin therapy is most effective when dosage is frequently adjusted. We sought to evaluate the effort required to maintain A1C below 7% once attained in older patients with type 2 diabetes.
  
  
  METHODS
  A total of 2380 insulin dosage adjustment episodes were analyzed for their intensity and frequency. The data were divided into an "induction period" (n=608), defined as the time before subjects' A1C dropped below 7% for the first time, and a "maintenance period" (n=1772), defined as the remaining study period. The data originated from a published study and included 26 older subjects with suboptimally controlled type 2 diabetes treated for a year with intensive insulin therapy. To achieve therapy goals, the study team contacted the subjects once every few weeks, reviewed records and optimized the insulin dosage.
  
  
  RESULTS
  During both the induction and maintenance periods, insulin dosage (both long-acting and fast-acting) was adjusted by more than 20%. Maintaining A1C below 7% required dosage adjustments every 2.7(±1.0) weeks, averaging 11.4% (±4.0) in 2.0 (±0.3) different components of insulin dosage (i.e., two of either long-acting or short-acting for breakfast, lunch or dinner) per contact.
  
  
  CONCLUSIONS
  Considerable effort was required to maintain optimal A1C levels in older patients with type 2 diabetes. Since the full benefit of insulin therapy is attained only when multiple components of insulin dosage are frequently adjusted and given the growing shortage of care providers' availability, innovative approaches are needed to empower patients to safely make their own insulin adjustments.
authors.affiliation: University of Michigan, College of Literature, Arts & Sciences, Ann Arbor, MI, USA.
authors.forename: Elyse S
authors.initials: ES
authors.lastname: Rosenthal
authors.forename: Eran
authors.initials: E
authors.lastname: Bashan
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Israel
authors.initials: I
authors.lastname: Hodish
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000523:psychology; D015331:Cohort Studies; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D016903:Drug Monitoring / Q000191:economics / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000523:psychology; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000627:therapeutic use; D061266:Insulin, Short-Acting / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D061266:Insulin, Short-Acting; C517652:hemoglobin A1c protein, human